Major Vascular Injury Secondary to Laparoscopy

Abstract

Laparoscopic procedures are now performed by almost all surgeons. Major vascular injuries secondary to laparoscopy, which were anecdotal before 1990, are now seen more often. This article focuses on the authors' experience with arterial trauma related to laparoscopic procedures. Their hospital is a regional center with a population base of 350,000 and six peripheral hospitals. Between August 1994 and March 1996, 6 patients inadvertently sustained major vascular injuries in the course of laparoscopic surgery. These incidents were shared by 5 different surgeons in four different hospitals. Three patients sustained intestinal perforation and aortic transection during laparoscopic cholecystectomy, two related to insertion of the veress needle and one to insertion of a trocar. Two of these injuries were repaired by end-to-end anastomosis, while the third one required a synthetic aortic graft. A fourth patient sustained an aortic perforation during laparoscopic tubal ligation. The fifth and sixth patients had an iliac artery perforation-one during laparoscopic appendectomy and the other during abdominal hysterectomy. Blood lost in these patients varied between 3 and 26 liters, and the length of hospital stay varied from six days to three months. No deaths were reported. Major vascular injuries may arise during laparoscopic procedures. The authors' experience suggests these incidents are underreported. By understanding the way they occur, they believe these injuries are preventable.